By Robert E. Hunter

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During surgery, plan to prevent and monitor for iatrogenic leg compartment syndrome. ARIF of tibial intercondylar eminence avulsion fractures using nonabsorbable sutures passed through drill holes and tied over the tibial tubercle is my currently preferred technique. Radiographs of well-performed ARIF of tibial intercondylar eminence avulsion fractures may show a few millimeters of fracture displacement. Functional outcomes are excellent. Arthroscopic reduction with rigid internal fixation allows early motion for rehabilitation.

TREATMENT The key to treating arthrofibrosis of the knee successfully is identifying the cause. Once the cause has been identified, a treatment plan can be created and carried out to correct it. If the cause is not corrected and only the stiffness is treated, the arthrofibrosis will undoubtedly recur. Indications and Contraindications It is important for the surgeon to understand the indications and contraindications for arthroscopic or open lysis of adhesions (Box 4-1). The most common mistake is to operate too soon on a stiff knee.

These two cuts are connected medially to laterally and the bone fragment is then moved superiorly, enough to correct the patella baja. As the bone fragment moves superiorly, it automatically proceeds anteriorly. It is fixated with one to two screws. The defect created by the osteotomy is then bone-grafted (Fig. 4-7). Conservative Management Prevention is the best treatment for arthrofibrosis. Range-ofmotion (ROM) exercises should be initiated as soon as possible after surgery. Other postoperative measures that can be taken to prevent stiffness include immediate quadriceps exercises, patellar mobility exercises, and obtaining early extension.

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